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Correlating infectious outcome with clinical parameters of 1130 consecutive febrile infants aged zero to eight weeks
W A Bonadio1, H Webster, A Wolfe
1Department of Pediatrics, Medical College of Wisconsin.
Insights
Young infants under four weeks old have double the risk of positive sepsis cultures compared to older infants. Invasive bacterial infections in this group were often linked to lower fevers and common pathogens like Group B Streptococcus.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatal Care
Background:
- Febrile young infants undergo sepsis evaluations in emergency departments.
- Early identification of bacterial infections is critical for timely treatment.
- Understanding pathogen prevalence and risk factors in neonates is essential.
Purpose of the Study:
- To characterize infectious outcomes in febrile infants aged 0-8 weeks undergoing outpatient sepsis evaluation.
- To identify clinical parameters associated with infectious outcomes in this population.
- To compare infection rates and pathogen types between neonates (0-4 weeks) and young infants (4-8 weeks).
Main Methods:
- Retrospective review of 1130 febrile infants (0-8 weeks) over seven years.
- Standard sepsis evaluation including blood, cerebrospinal fluid, and urine cultures.
- Analysis of culture results, pathogen identification, and clinical data.
Main Results:
- 8.5% of infants had a positive bacterial culture; 58% were in the 0-4 week age group.
- The rate of positive cultures was double in infants aged 0-4 weeks (12%) versus 4-8 weeks (6%).
- Invasive bacterial infections (49 cases) were often associated with temperatures below 39°C, with Group B Streptococcus and E. coli being the most common pathogens.
Conclusions:
- Younger infants (0-4 weeks) face a higher risk of bacterial sepsis.
- Fever severity may not be a reliable indicator for invasive bacterial infections in this age group.
- Common neonatal pathogens dominate invasive infections, unlike in older infants.
Abstract:
The study objectives were to characterize the infectious outcomes and associated clinical parameters of a large group of febrile young infants who received outpatient sepsis evaluation. This retrospective review of consecutive cases during a seven-year period was set in an urban pediatric emergency department. Febrile infants, aged zero to eight weeks, were the participants. All received a standard evaluation for sepsis, including complete blood count/blood culture, lumbar puncture/cerebrospinal fluid culture, and urinalysis/urine culture. Of 1130 patients, 447 (42%) were aged zero to four weeks, and 683 (58%) were aged four to eight weeks. In 96 cases (8.5%), a bacterial pathogen was isolated by culture of cerebrospinal fluid, blood, urine, or stool; 58% were aged zero to four weeks and 42% were aged four to eight weeks. The rate of positive cultures per patient age was doubled in those aged zero to four weeks (12%) compared with those aged four to eight weeks (6%). The 49 cases of invasive bacterial infections (bacterial meningitis/bacteremia) were most commonly associated with lower degrees of fever, as slightly over one half (25/49) had temperature < 39 degrees C. The most common pathogens of invasive bacterial infection were group B streptococcus and Escherichia coli, accounting for 33 of 49 cases (67%); the most common pathogens of invasive bacterial infection in older children (Haemophilus influenzae type b and Streptococcus pneumoniae) were relatively underrepresented, accounting for only five of these 49 (10%) cases.